The Effect Of Esketamine On Postoperative Cognitive Dysfunction In Elderly Patients Undergoing Laparoscopic Radical Resection Of Rectal Cancer

Objective:To investigate the effect of esketamine on postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of rectal cancer.Methods:Sixty elderly patients who underwent laparoscopic radical resection of rectal cancer in our hospital from January 2021 to December2021 were selected,BMI18～24kg/m,ASA gradeⅡ～Ⅲ.Two groups（n=30）were divided into control group（group C）and esketamine group（group E）by random number table method.Before anesthesia induction,atropine 0.3mg,midazolam 0.03mg/kg were given intravenously in both groups;Sufentanil 0.5ug/kg,propofol 1.5～2.5mg/kg,rocuronium0.6mg/kg were given intravenously for anesthesia induction in group C;Esketamine 0.4mg/kg was given intravenously in group E.Propofol 1.5～2.5mg/kg and rocuronium 0.6mg/kg were used to induce anesthesia.During induction,ephedrine treatment was given if the mean arterial pressure（MAP）was less than 70mm Hg.Group C was continuously pumped with remifentanil 10～20ug/（kg·h）and propofol 5～10mg/（kg·h）;Group E was continuously pumped with Esketamine 0.5mg/（kg·h）and propofol 5-10 mg/（kg·h）.Both groups were given intermittent rocuronium bromide for intraoperative maintenance,and the BIS value was maintained between 40 and 60.In group C,remifentanil and propofol were stopped 5minutes before the end of operation.Esketamine hydrochloride and propofol were stopped 30 minutes before the end of operation in group E.Heart rate（HR）,systolic blood pressure（SBP）and diastolic blood pressure（DBP）were recorded before anesthesia induction（T₀）,6 hours after surgery（T₁）and 12 hours after surgery（T₂）.The levels of inflammatory factors TNF-α,IL-1β,IL-6,IL-10 and MIP-2 were detected before anesthesia induction（T₀）,1 day after surgery（T₃）and 3 days after surgery（T₄）,and MMSE score was performed.Recovery time and ephedrine use were recorded in both groups.Adverse reactions were recorded within 12hours after surgery:respiratory depression and VAS score>3.Results:1.There were no significant differences in age,gender,ASA grading,BMI,blood loss,urine volume and recovery time between the two groups（P>0.05）,indicating comparability.2.At T₀,there were no significant differences in heart rate,systolic blood pressure and diastolic blood pressure between the two groups（P>0.05）;Compared with group C,the heart rate,systolic blood pressure and diastolic blood pressure of group E at T₁and T₂were lower,and the differences were statistically significant（P<0.05）.3.At T₀,there was no significant difference in the inflammatory cytokines TNF-α,IL-1β,IL-6,MIP-2 and IL-10 between 2 groups（P>0.05）.Compared with group C,inflammatory cytokines TNF-α,IL-1β,IL-6and MIP-2 in group E at T₃and T₄were lower,with statistical significance（P<0.05）;IL-10 in group E at T₃and T₄was higher than that in group C,with statistical significance（P<0.05）.4.There was no statistical significance in MMSE scores between T₀and 2groups（P>0.05）;Compared with group C,the MMSE scale score of group E at T₃and T₄was higher,and the difference was statistically significant（P<0.05）.5.Compared with group C,the incidence of POCD in group E was lower,and the difference was statistically significant（P<0.05）.6.Compared with group C,group E used less ephedrine,and the difference was statistically significant（P<0.05）.7.There were statistically significant differences in the incidence of respiratory depression and VAS score>3 within 12 hours after surgery between the two groups（P<0.05）.Conclusion:In summary,esketamine can improve postoperative cognitive function in elderly patients undergoing laparoscopic radical rectal cancer surgery,and the mechanism may be related to reducing the levels of TNF-α,IL-1β,IL-6,MIP-2 and increasing the levels of IL-10.